Surviving Maintenance of Certification and Learning from It: How APA Supports its Members APA Division of Education

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1 Surviving Maintenance of Certification and Learning from It: How APA Supports its Members APA Division of Education

2 New Approaches to Physician Education Lifelong Learning Maintenance of Certification Core Competencies Integrated Care Team-based learning

3 Can We Rethink Our Approach to the Medical Education Continuum? Premedical Medical School Residency and Fellowships Practice 2009 AAMC. May not be reproduced without permission.

4 Create a True Continuum Premedical Medical School Residency and Fellowships Practice 2009 AAMC. May not be reproduced without permission.

5 AAMC FSMB AHME ABMS CMSS AMA AHA Medical Schools State Boards Specialty Societies NBME Specialty Boards MCAT USMLE Cert Exams CME Recert/ MOC Subject Exams In-Training Exams Premedical Medical School Residency and Fellowships Practice LCME ACGME ACCME NCQA JCAHO 2009 AAMC. May not be reproduced without permission.

6 Maintenance of Certification The APA has a demonstrated commitment to help its members with MOC by keeping them well-informed and facilitating their provision of the highest level of evidence-based care Where did it come from? What are the requirements? How the APA can help

7 Who is Involved in MOC? American Board of Medical Specialties (ABMS) Oversees 24 member boards, including ABPN Board Certification is voluntary State Licensing Boards 70 Physician Licensing Boards 62 have traditional CME requirements Federation of State Medical Boards approved a policy of Maintenance of Licensure (MOL) in 2010 Several states will pilot MOL programs- MOL does NOT require MOC American Medical Association Evolving the AMA PRA CME system to include PI CME, SA CME and MOL CME ACCME (Accreditation Council for Continuing Medical Education) Oversees CME accreditation standards and compliance Members of board appointed by AMA, ABMS, AHA, AAMC, CMSS, FSMB

8 Important Influence outside the Existing CME system Institute of Medicine Reports to congress: To Err is Human, 1999 Crossing the Quality Chasm, 2001 Center for Medicare Services Structures Reimbursement rates Incentives PQRI Health Care Reform Accountable Care Act May require patient feedback for physicians Health Insurance Industry WellPoint and Blue Cross have already developed approved MOC programs for physicians

9 Evolution of CME 1961 AMA - AAMC Conference 1/3 of physicians did no post graduate medical education First national discussion of CME as medicine underwent rapid treatment evolution AMA PRA Accreditation System for CME 1967 New Mexico first State Licensing Board to require CME Growing evidence that CME credits are not sufficient to improve physician performance Davis, Dave et. al. JAMA, 1995, 1999, 2006

10 APA Support for MOC APA provides its members with resources needed to meet ABPN MOC requirements At no cost: Online PIP clinical modules (MOC part 4) online at apaeducation.org At no cost: efocus self-assessment - and online at apaeducation.org (MOC part 2- up to 25 credits ) With Annual Meeting Registration: Self-Assessment Exam (Part 2) Focus Journal subscription: meets all MOC requirements, continuous over subscription CME, Self-assessment, PIP Focus MOC Workbooks: by topic, self-assessment and PIP

11 MAINTENANCE OF CERTIFICATION Mandated by the American Board of Medical Specialties for all Board Certified Physicians ABPN MOC Requirements: Part 1 Professional Standing (Maintain a license) Part 2 Lifelong Learning (CME and Self Assessment) 90 hours of CME every 3 years/or 30 per year, including 24 hours of Self- Assessment CME Diplomates entering C-MOC in 2016 and after are required to demonstrate successful completion of a Patient Safety Course in 2016 Part 3 Cognitive Expertise (pass the exam) ABPN Recertification Exam every 10 years, must meet Part 2 and 4 requirements in order to take the exam Part 4 Performance in Practice (PIP) -Improvement in Medical Practice Clinical Module: review of 5 patient charts using ABPN approved modules Feedback Module (6 choices: 5 patient surveys, 5 peer evaluations, 5 resident evaluations, 360 degree evaluation, institutional peer review, one supervisor evaluation) For further information go to

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14 The Journal of Lifelong Learning in Psychiatry One subscription meets all needs for MOC! Quarterly journal, print and online, Focus covers major recertification topics in 4 year cycles -20 hours of CME per issue, annual selfassessment exam (24 hours of SA-CME) and Performance in Practice (PIP) modules IN EACH ISSUE: Clinical synthesis and comprehensive review articles by experts Patient Management Exercise Ask the Expert Column Ethics and Professionalism Column Communication Column Influential Publications - reprints selected by consensus of authors and advisors; including a section on Systems of Care Member cost = $368; non-member cost = $590

15 FOCUS SELF-ASSESSMENT EXAMINATION Approved by ABPN for MOC Part 2 Annual supplement to the journal. Can be completed online or in print 120 multiple-choice, Board-type questions, written by academic experts in a rigorous peer-review process Score, norms, performance guidelines (by topic and demographics) sent to physicians who submit. Identify problem areas by comparison of own score to aggregate norms Critique and Reference Book: expert critique for each question by FOCUS editorial board provides answer, rationale, and cites references for study Serves as an important resource in preparation for the recertification exam Offers multiple approaches to self-assessment process for multiple learning styles

16 2014 efocus Program: Understanding the Evidence for Off Label Use of Atypical Antipsychotics

17 2014 efocus Program: Understanding the Evidence for Off Label Use of Atypical Antipsychotics

18 Peer Comparison Treatment Approach: 93% 5% 2% Electroconvulsive Therapy (ECT) (2%) Switch from quetiapine to a first generation "neuroleptic," such as thiothixene or haloperidol (0%) Switch from quetiapine and olanzapine to clozapine (93%) Would not change pharmacotherapy, but rather add cognitive behavioral therapy (5%)

19 Performance in Practice Modules: MOC Part 4- Member Benefit Performance in Practice (PIP) modules are approved by ABPN and first published in Focus Four PIP modules are currently available at no cost to APA members ($399. each for nonmembers) on the APA websitewww.apaeducation.org New PIP modules for 2014: Psychiatric and Medical History Psychopharmacology

20 Performance in Practice Modules: MOC Part 4- Member Benefit Major Depressive Disorder 5 hours of CME credit, approved by ABPN Schizophrenia Available free online approved by ABPN PTSD 5 hours of CME credit, approved by ABPN for MOC Part 4 Suicide Assessment Available free online approved by ABPN Substance Use/Abuse Screening Available free online approved by ABPN Substance Abuse Assessment and Treatment Available free online approved by ABPN

21 Laura J. Fochtmann, M.D., Farifteh F. Duffy, Ph.D., Joyce C. West, Ph.D., M.P.P., Robert Kunkle, M.A., and Robert M. Plovnick, M.D.

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23 PERFORMANCE IN PRACTICE (PIP) MODULES Overview To earn AMA PRA Category 1 Credit Physicians must use the assessment tools as indicated. Physicians who complete Stages A-C may earn up to 20 AMA PRA Category 1 Credits Participants must complete an evaluation survey for each of the three stages Credit is awarded: Stage A = 5 credits Stage B = 5 credits Stage C = 10 credits Stages are completed within 24 months (within a reasonable time to make and assess improvements) After completion of the activity, physicians will have the foundation for performance improvement initiatives aimed at enhancing outcomes for patients through evaluating and treating

24 Through chart review, the physician uses the PIP forms provided to assess whether their current screening, or their current assessment and treatment is consistent with evidence-based recommendations. Program Evaluation Stage A complete the evaluation for Stage A CME Credit for Stage A 5 AMA PRA category 1 credits After comparing your recorded patient data to quality measures in Stage A, the physician should assess, initiate and document a plan for improvement. Program Evaluation Stage B complete the evaluation for Stage B CME Credit for Stage B 5 AMA PRA category 1 credits Within 24 months following initial completion of Stage A, Revaluate your performance. Compare Stage C chart reviews with Stage A reviews using the checklist provided. Program Evaluation Stage C complete the evaluation for Stage C CME Credit for Stage C 10 AMA PRA category 1 credits

25 MOC Workbook Series: PTSD: August, 2014

26 FOCUS MOC Workbook Series Major Depressive Disorder Earning CME Credit and Fulfilling MOC Requirements Stage A Chart Review and Evaluation Stage B - Improvement Plan Stage C - Chart Review and Evaluation Practice Guideline Real Time Tool for Patients with MDD How to Claim CME credit and Evaluation of the Activities

27 New MOC Products Online Patient Safety Course for Psychiatrists Covers basic patient safety curriculum and special issues for psychiatry Focus Psychiatry Review Volume 2 Revised for DSM 5 Psychopharmacology Master Course at the Annual Meeting Self-Assessment credit and Part 4 MOC Practice Assessment will be offered in addition to CME credit Plan to Offer MOC Activities for Courses at 2015 Annual Meeting AHRQ Grant Self-Assessment Credit - Off-Label Use of Atypical Antipsychotics

28 How APA Can Help Contact APA for help with your transcript or help with access to MOC activities Contact the Department of CME Kristen Moeller Contact APA Customer Service with Questions about your FOCUS subscription or APA username and password Customer service